Basic Intravenous Therapy- Test 2 Flashcards
Purposes of IV therapy
Fluid and electrolyte therapy
medication administration
Blood products administration
TPN (total parental nutrition)
What is IV therapy
Infusion of fluid directly into the circulation
TPN
Total Parental Nutrition
When would you use a butterfly needle
- short term IV therapy
- vein that is difficult to start an IV
What is a steel needle called
Butterfly
Characteristics of a steel needle
Rigid, metal, with plastic wings
Advantages/disadvantages of butterfly needle
Advantages
-easy to insert
Disadvantages
-not flexible, irritating
What is the common IV access device ?
Characteristics?
Over the Needle Catheter
Flexible plastic catheter with guide needle for insertion
How is Over the Needle Catheter inserted
Inserted using a steel guide needle for insertion and then after insertion the steel guide is removed and the flexible catheter is left behind
Advantages/disadvantages of Over the Needle Catheter
Advantages
- flexible, can use near joints, less irritation
Disadvantages
- more difficult to insert
What safety mechanism does a ONC have?
Autoguard
The needle springs back when barrel button is presses after catheter is inserted
**this prevents the nurse from having needle sticks when the steel guide needle is withdrawn
What are the two options for tubing
Macrodrip
Microdrip
What is drop factor
Size of drip itself
Drop factor for macrodrip
10 to15 drops/ml
Used with adults
Drop factor for microdrip
Used for?
60 drops/ml
Used for slow and accurate rates
Children and critical care
Blood tubing has a special….
Filter
What is a piggyback tubing used for
Secondary infusion of medications
How should you handle IV fluids
As if they are prescribed meds
What should you inspect a IV fluid bag for
Expiration date, additives present, clarity of solution, leaks
How many times should you read a IV fluid bad label
3 times
Abbreviations: Dextrose= Water= Lactated Ringers= Normal Saline= 5%=
Dextrose= D Water= W Lactated Ringers= LR Normal Saline= NACL 5%= 5
What’s another name for ONC
Angiocatheter
What does D5 .2NaCl
5% Dextrose .2% sodium chloride
What is a gravity drip influenced by
- height of solution bag compared to patient
- size and patency of IV catheter
- position of extremity
- are there kinks in the line
What is timing tape used for
Used monitor amount infused hourly
What are the uses of a “Positional” gravity drip IV
General fluids-hydration
Emergency- start with gravity drip until IV infusion pump can be located
What is something that should be known about “positional” gravity drip IV
Rate varies greatly with movement
What must you do with a Infusion Pump
Continue site assessment & infusion rate
** machines are not perfect
What machine accurately infuses solution at rate prescribed
Infusion pump
What is PCA
Patient Controlled Analgesia
What does a PCA do?
- Delivery of pain medicine through IV infusion
- client medicated self for pain
- machine is set to deliver specific individual dose of medication when pt presses a button
- limit set
- security lock to prevent setting changes
Does a patient on a PCA use more or less pain medicine than a patient who needs to ask nurse for medicine
Less
What are needle less systems used for
To prevent unnecessary exposure to contaminated needles
What is priming
Remove all of air from the tubing
When spiking a IV the equipment must be…
Sterile, closed system
Tubing should be changed every ___ hours
24 hours
What is timing tape used for
Along side of the bag with hourly markings
You should inspect the IV site every ____ hours
2 hours
What should you check the IV site for
Needle placement, redness, edema, color, temperature, presence of pain
You should change gauze dressings every ____ hours
48 hours
You should change transparent every ______ hours
48-72 hours
At the change of dressing what should you do
Clean skin carefully
IV rate calculation
Volume x drop factor / time (minutes)
= drops per min
How should you count the drip rate
15 seconds
Then 30 seconds
Then 1 full minute
What are 4 things you should remember about timing tape?
- don’t cover up the name of the solution
- start at the top of IV bag and mark hourly
- use ink, not felt marker because it will soak through the bag
- inspect bag hourly to see if rate of infusion is “on time”
What does “on time” mean
+/- 10% of rate prescribed
Can you catch up the infusion rate if it is behind?
No! Must have a physicians order to alter infusion rate
What does KVO mean
Keep vein open rate
Slowest possible rate which will maintain patency of IV and not clot off
When do you use a KVO
When waiting on a physicians order
Why are KVO not used routinely
Can vary so much from patient to patient
Standards for IV therapy come from
CDC and INS
center for disease control and intravenous nursing standards
Can agency policies go beyond standards?
Yes
But they can never be less than standards
What should you remember about solutions
Read label carefully (including additives), inspect expiration date, clarity, leaks, change every 24 hours or when empty
What should you inspect when looking at tubing and when should it be changed?
Inspect for air in line and check drip chamber
Change every 48 hours (label with date and time)
What should you check with site dressing? When should it be changed?
Check securement
Change every 24 hours according to policy
What should you check when looking at an IV site? When should you change it?
Inspect for swelling, color, warmth, pain
Change site every 48 to 72 hours or when a complication occurs
When should you discontinue a IV
D/C IV if physician orders or if complication occurs
When you D/C a IV what should you do
Apply pressure 1-2 minutes continuously with gauze bad (not alcohol) and don’t pull up gauze to look at it
Apply band aid after bleeding stops
DOCUMENT why IV was d/c
If a patient is on blood thinners and you D/C an IV how long should you apply pressure to site
5 minutes
When should you document?
Initial assessment at start of care shift
Then every 2 hours
And at end of care shift
You should asses for _____ to ________
Top to bottom
Bag to site
What is infiltration?
Cause?
Fluid infuses into subcutaneous tissue and is around vein instead of through vein
Cause: catheter punctures vein wall
Signs and symptoms of infiltration
Swelling in area, pain, pale/cool to touch because circulation being compromised in that area
Nursing actions with infiltration
d/c IV
Depending on type of fluid that was in sub a tissue warm or cool compress to that area
What is phlebitis
Vein inflammation
What is thrombophlebitis
Inflammation of vein with clot formation
Causes of phlebitis/thrombophlebitis
Mechanical or chemical irritation
Signs and symptoms of phlebitis/thrombophlebitis
Warm to touch, red, very painful
Nursing actions with phlebitis/thrombophlebitis
D/c IV, apply warm compress to area
What is fluid overload?
Signs and symptoms ?
Too rapid of an infusion
SS: increased pulse, increased BP, fluid in lungs to auscultation
Nursing actions with fluid overload
Slow IV to a KVO rate
do NOT d/c IV
Notify physician
May give IV diuretics
